路径依赖下的农村合作医疗——以日本农村医疗保险为例

Path-dependence in Rural Cooperative Medical Care System: the example of Medical Schemes in Rural Japan

日本农村医疗保险主要由强制性的国民健康保险和自愿参加的农协医疗互助保险组成。其绩效主要体现在覆盖面广、保障全面、保险机构管理科学、反映了农民的自我意愿等方面。中国的农村合作医疗在半个多世纪的制度变迁中,其兴衰成败依赖于政府支持力度的强弱,始终定位于"互助共济",强调"自愿参加",制度供给沿袭着城乡分割的"二元保障"路径。日本农村医疗保险已日臻完善,对我国正在实施的新型农村合作医疗制度有借鉴与启示作用。

Medical schemes in rural Japan consist of compulsive health insurance covering all people and Medical Scheme of Japanese Agricultural Cooperation Association with voluntary members. The achievements in Japan suggest the wide coverage, comprehensive security, scientific management of insurance facilities and meeting the rural people＇s demands. The Rural Cooperative Medical Care System in China has experienced the reform in half of a century and its success depends on government support. And it is orientated to freemasonic characteristic and emphasizes on the voluntary participation, and system supply follows the dual-insurance path. Medical Schemes in Rural Japan is perfecting, and China can make the reference from it.